82 ANNALS OF SUI\GEI\ Y TR.ANSPLANTING A HEAR. T O NE of the many works of the fifteenth -century painter F ra Angelico has aroused the in- terest and admiration of a small society whose members are not usually thought of as aficionados of Renaissance art. That is the exclusive, high-tech frater- nity of researchers in human-organ transplantation, and its members have become fascinated by Fra Angelico's "Saints Cosmas and Damian T rans- planting a Leg," in the Museum of the Church of San Marco, in Florence. The subjects of the painting are two brothers, pious Christian physicians who ministered to the poor in the southeastern corner of Asia Minor during the third century. Because they did not accept payment for their services, they were among those called by the Greeks hoi anargyroi-the sil- ver less ones. Arrested and tortured by the Romans in 303, during the Emper- or Diocletian's religious persecutions, Cosmas and Damian refused to re- nounce their faith, and were beheaded. In time, they became the patron saints of surgeons and physicians. After their martyrdom, numerous legendary deeds were attributed to the two saints, the most persistent of which, perhaps because it epitomizes their healing ministry, is the one memorialized by Fra Angelico. In the painting he depicts the brothers in the act of grafting the healthy leg of an Ethiopian donor onto the body of a bell-tower cus- todian who had undergone amputation for either cancer or gangrene. So popular was the theme of this miracle that there are at least three other well- known representations of it in European museums, all made within two hundred years of the Fra Angelico painting. The myths of transplanta- tion appeal to that part of the human mind which clings to the hope that life can be made eternal. If only it were possible to replace worn-out or sick body parts with healthy new ones, there would be no need to die; at the very least, waning vigor this century seemed too far-off to hope for, has gone so rapidly from being a fantasy to being standard surgical practice. I am a general surgeon. During my years of training, which ended in the early nineteen-sixties, I learned to per- form all the cardiac operations that could then be done (even at that time the list was not short), and although it gradually became clear to me that I had neither the personality nor the temper- ament of a cardiac surgeon, I have never lost a certain awe at the in- tricacies of the heart and at the skill of the doctors who treat it. And, like al- most everyone else, I have been aston- ished at what has been accomplished in the field of transplant science in such a very short time. One day, I decided to see for myself. Although I had observed segments of the transplant process, I had never followed an individual patient through the entire course of his operation and recovery. I asked Y ale-N ew Haven Hospital's transplant-research fellow, Dr. George Letsou, to call me when his team was readying itself to perform its next car- diac transplant. might be restored. As early as the seventh century B.C., Hindu surgeons were reconstructing injured noses us- ing the patients' own skin. In late- eighteenth-century London, the Scot- tish surgeon John Hunter managed to transplant a human tooth into the comb of a cock. He also grafted testicles from one chicken onto another But these were isolated successes, and, though tantalizing in their implications, they led nowhere. Until recently, the at- tempt to transplant organs from one human being into another has been among the most chimerical of the quests of science. Things have changed, however: we are now living in an age of scientific miracles. Every day, in medical centers throughout the world, people of all ages leave operating rooms carrying within them hearts or lungs or kidneys or pancreases that began life in the bodies of others. In July of last year, for example, a man I'll call Anthony Cretella underwent a heart transplant. There was nothing about his opera- tion, his postoperative course, or his recovery that his cardiologists and sur- geons did not consider routine. And that may be the greatest miracle of all-that an operation so complex and technologically demanding, an opera- tion that as recently as the middle of T HE muscular wall of the heart is nourished not by the blood within its chambers but by a group of vessels that are embedded in its sur- face and encircle the top of the heart like a crown, and are therefore called coronary arteries. Major branches of the coronary arteries descend toward the heart's tip, diverging into smaller ves- sels along the way, to ir- rigate the muscle with bright-red, nourishing blood from the body's largest ar- tery, the aorta. When the coronaries become narrowed by spasm or by thickened plaques ( a condition called - __ arteriosclerosis), or both, the heart responds the way an overworked calf muscle does when it cramps. The result- ing pain is called angina pec- toris-from the Latin verb angere, meaning "to choke or throttle," and the noun "You've got him. Edward the AccessibLe at your servzce."